THROMBOELASTOMETRY AS GUIDANCE FOR BLOOD MANAGEMENT IN PATIENTS UNDERGOING CARDIAC SURGERY
Sarrais C, Alonso A, Álvarez L, Sáchez JJ, Beltrao R, Aguilar C.

BACKGROUND: Thromboelastometry (ROTEM®) is a viscoelastometric method for a dynamic and globally haemostasis testing in a whole blood sample.  The aim of this study was to assess the results of using thromboelastometry as guidance for blood management in cardiac surgery.

METHODS: Analytical interventional quasi-experimental comparative non-randomized prospective study with a retrospective control group. Our inclusion criteria for the 62 patients in the study were: patients undergoing an at least second cardiac surgery, endocarditis or type A aortic dissection. Patients were allocated to control group (C group) with routine transfusion practices during surgery (n=31) or treatment group (R group) with thromboelastometrically guided transfusion algorithm during surgery (n=31).
Main variable was allogeneic blood units transfused (red blood cells, fresh-frozen plasma and platelets). Secondary variables were ICU stay duration and postoperative adverse events.

RESULTS: The 62 patients were homogenously distributed in two groups but for dyslipidemia (more frequent in R group). Statistical analysis showed lower transfusion rates of fresh-frozen plasma in R group regarding C group (p<0.001) as well as higher use of prothrombine complex concentrate (p<0.05); 16% in C group before 38% in R group. What’s more fibrinogen infusion was increased in R group compared to C group with an average dose administered of 0.87gr and 0.35gr respectively (p=0.19). Transfusion of red blood cells was decreased during surgery with an average transfusion rate of 3.9 units in C group in comparison with 2.64 units in R group (p=0.125). Both last variables were not statistically significant probably due to a too small sample. There were no differences in transfusion rates during ICU stay between both groups. In addition we found a lower rate of respiratory adverse events in R group (p<0.05). Regarding ICU stay duration, average stay in C group was 7.45 days compared to 5.13 in R group (p=0.34).

CONCLUSIONS: Based on our own experience, using thromboelastometry guidance for blood management lead to a meaningful reduction of fresh frozen plasma transfusion during surgery. This fact probably brought to the decrement in respiratory adverse events after surgery and ICU stay in our patients.

KEYWORDS: thromboelastometry, blood transfusion/management, cardiac surgery.

Thromboelastometry as guidance for blood management in patients undergoing cardiac surgery